International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391 Evaluation of Alteration of Serum Uric Acid Level in Hypothyroid and Hyperthyroid Patients in a Tertiary Care Hospital

Dr. Sayari Banerjee1, Dr. Jayati Roy Choudhury2

1, 2Department of Biochemistry, College of Medicine and Sagore Dutta Hospital

Abstract: It has been demonstrated by several studies that thyroid function can affect almost all metabolic activity. Both hypo and hyperthyroidism have potentially fatal systemic manifestations. Hypothyroidism is a clinical syndrome resulting from a deficiency of thyroid hormones which, in turn, results in a generalized slowing down of all metabolic processes. Hypothyroidism is associated with many biochemical abnormalities including increased uric acid levels. Reason behind hyperuricaemia in patients with hyperthyroid status, who are expected to have a higher renal clearance of uric acid may be the increased uric acid production secondary to increased overall metabolism in hyperthyroid patients. According to null hypothesis there is no significant relationship between thyroid status and uric acid level. Justification of this present hospital based non interventional case control study was designed to find any association between uric acid level with hypothyroidism and hyperthyroidism in comparison to normal control. In our study we find that 50 patients of primary hypothyroidism also suffers from hyperuricemia whereas there is also significantly high uric acid level found in primary 31primary hyperthyroid patients in comparison to euthyroid population.

Keywords: Hypothyroid, Hyperthyroid, Euthyroid, Hyperuricemia

1. Introduction hypo/hyperthyroidism, any substance abuse, chronic alcoholic, any drug intake that affect renal and liver It was asserted by various studies that hypothyroidism is function, Chronic inflammatory disease. Experiment design associated with many biochemical abnormalities including taken was non interventional, hospital based case control increased uric acid levels.1 Probable reason behind study. Serum TSH and totalT4 by ELISA method. Serum hyperuricaemia in patients with hyperthyroid status, who are urea, creatinine and uric acid were measured by expected to have a higher renal clearance of uric acid may autoanalyzer EM360 to exclude any renal compromise. be the increased uric acid production secondary to increased Statistical analysis was performed by Q software after overall metabolism in hyperthyroid patients surpassing uric obtaining data at the end of study. Mean, Standard deviation acid dieresis caused by hyperthyroidism.2 Studies done in was calculated for both cases and control population. different countries also demonstrated weak or no significant Student’s T test was calculated to detect any significance relations between uric acid level and thyroid hormone status. difference between case and control. A two-sided p value In our present study we tried to find out the association of <0.05 was considered statistically significant. uric acid level in both hypothyroid and hyperthyroid individuals provided that renal function tests are normal in a 3. Result tertiary care hospital in West Bengal. Very few studies are done in this region so result of our study would emphasize Table 1 shows mean serum TSH, total T4 and serum uric the need for evaluation of serum uric acid levels in altered acid level in euthyroid, hypothyroid and hyperthyroid thyroid hormone status. population.It was evident from table 1 that mean serum uric acid levels in both the cases are higher than control 2. Materials and method population.

In the present study all the blood samples were collected in Table 1: Mean serum TSH, total T4 and serum uric acid OPD clinical biochemistry laboratory of College of level in euthyroid, hypothyroid and hyperthyroid Medicine and Sagore Dutta Hospital. Permission for this Euthyroid Hypothyroid Hyperthyroid study was taken from Institutional Ethics committee. Newly Serum TSH (mean) 2.21mIU/ml 15.16mIU/ml 0.20mIU/ml diagnosed case of hypothyroidism and hyperthyroidism in Serum total T4(mean) 10.1mIU/ml 2.12 mIU/ml 15.5mIU/ml the age group 20-60year, both male and female before Serum uric acid (mean) 4.1mg/dl 6.9mg/dl 6.7mg/dl introduction of any kind of thyroid medications were taken as cases after obtaining informed consent. Age and Sex Student’s T test was calculated to detect any significance matched control cases were taken. All participants were difference between case and control which shows that two- categorized by their thyroid stimulating hormone (TSH) tailed P value for hypothyroid and euthyrroid uric acid s levels as having euthyroid (TSH 0.35–6 mIU/mL) or control, equals 0.0011. By conventional criteria, this difference is hypothyroid (TSH>6 mIU/mL) and hyperthyroid (TSH, 0.35 considered to be very statistically significant. In case of mIU/mL) status. Hyperuricaemia was defined as a serum hypertthyroid and euthyroid uric acid Student‘s T test also uric acid level above 6.6 mg/dL in men or above 5.5 mg/dL appears significant with a p value<0.005. in Women. Detailed clinical history was taken to exclude any chronic illness like DM, hypertension, CRF, Secondary

Volume 7 Issue 1, January 2018 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Paper ID: ART20179568 DOI: 10.21275/ART20179568 1010 International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391 According to Lai-Chu See et al the prevalence of hyperuricaemia was higher in hyperthyroid subjects (19.4%) than in euthyroid subjects (17.8%) but not inhypothyroid subjects (19.3%.8 In a study on 12 induced hypothyroid rabbits, mean serum uric acid level was found higher in hypothyroid condition than in euthyroid condition9. In an epidemiological study in northern Finland in 1969, hyperuricemia was found in rural, urban and hospital admitted hypothyroid patients10. In a case-control study done Diagram 2: Mean uric acid level in Euthyroid and in the Biochemistry Department of Bangabandhu Sheikh hypothyroid population Mujib Medical University, Dhaka, Bangladesh serum uric acid level has been found significantly higher in cases compared to controls.11According to a study done by Jia D et al.hypothyroidism patients had significantly higher levels of TSH than those in the control groups.12

5. Conclusion

According to various studies a significant correlation between thyroid function and purine nucleotide metabolism has been established in hypothyroidism. On the contrary, the relationship between hyperthyroidism and purine metabolism is more controversial.In conclusion we found a significant association between thyroid status and hyperuricaemia, both hypothyroid and hyperthyroid statuses were associated with a higher risk of hyperuricemia than Diagram 3: Mean uric acid levels in euthyroid and euthyroid control population provided renal function tests hyperthyroid population. are within normal limit. Our present study thus emphasizes necessity of evaluation of uric acid level in both hypothyroid 4. Discussion and hyperthyroid individual.

Thyroid hormone dysfunction can affect almost all 6. Declaration metabolic activities including purine nucleotide metabolisim. Hypothyroidism is a clinical syndrome  The manuscript is being submitted by Corresponding resulting from a deficiency of thyroid hormones which, in author on behalf of all the authors. turn results in a generalized slowing down of metabolic  There is no conflict of interest. processes on the other hand hyperthyroidism is a hyper  The manuscript is original work of all authors. metabolic state. Association between hypothyroidism and  All authors made a significant contribution to this study. hyperthyroidism with hyperuricemia was demonstated by  All authors have read and approved the final version of numerous studies. In our present study we found that the manuscript. hypothyroidism is associated with hyperuricemia. In comparison to the prevalence reported in the general population, a significant increase of both hyperuricemia and References gout was found in the hypothyroid patients. In [1] Greenspan FS. The thyroid gland. In: Greenspan FS& hypothyroidism the hyperuricemia is secondary to a Gardner DG (eds). Basic & Clinical Endocrinology. decreased renal plasma flow and impaired glomerular 7th edn. New York: The McGraw-Hill Companies, filtration. Giordano et al. conducted a study among 28 2004: 215-294. patients with primary hypothyroidism and showed 33.3% [2] Sato A, Shirota T, Shinoda T, Komiya I, Aizawa T, et prevalence of hyperuricemia in patients with al. (1995) Hyperuricemia in patients with hypothyroidism.In our study we also found significantly hyperthyroidism due to Graves’ disease. Metabolism high uric acid level in both hypothyroid and hyperthyroid 3 44: 207–211. patients. The association between hypothyroidism and [3] Giordano N, Santacroce C, Mattii G, Geraci S, hyperuricemia was first suggested in 1955 by Kuzell and Amendola A, Gennari C. Hyperuricemia and gout in colleague, who examined 520 patients suffering from gout thyroid endocrine disorder. Clin Exp Rheumatol.2001; and found hypothyroidismin 20% of the males and in 30% 4 19: 661-665. of the females. [4] Kuzzel Wc, Schaf Farzick Rw, Naugler We et al.: Some observations on 520 gouty patients. J Chronic On the contrary, the association between hyperthyroidism Dis 1955; 2: 64-8. and hyperruricemia has always been more controversial. In 5 6, [5] Ford Hc, Lim Wc, Chisnall Wn, Pearce Jm: Renal 1989 Ford et al in contrast with previous reports 7 function and electrolyte levels in hyperthyroidism: demonstrated that hyperthyroidism can cause urinary protein excretion and the plasma hyperuricemia through the increase of purine nucleotide concentrations of urea, creatinine, uric acid, hydrogen turnover and the decrease of renal urate excretion. Volume 7 Issue 1, January 2018 www.ijsr.net Licensed Under Creative Commons Attribution CC BY Paper ID: ART20179568 DOI: 10.21275/ART20179568 1011 International Journal of Science and Research (IJSR) ISSN (Online): 2319-7064 Index Copernicus Value (2016): 79.57 | Impact Factor (2015): 6.391 ion and electrolytes. Clin Endocrinol 1989; 30: 293- 301. [6] Yo Kogoshi Y, Saito S: Abnormal serum uric acid level in endocrine disorders. NipponRinsho 1996; 54: 3360-3. [7] SMYTH CJ: Disorders associated with hyperuricemia. Arthritis Rheum 1975; 18: 713-9 [8] Lai-Chu See, Chang-Fu Kuo, Kuang-Hui Yu*, Shue- Fen Luo, I-Jun Chou, Yu-Shien Ko, Meng-Jiun Chiou, Jia-Rou Liu. Hyperthyroid and Hypothyroid Status was strongly associated with Gout and weakly associated with hyperuricaemia. [9] Dariyerli N, Andican G, Catakoglu AB, Hatemi H, Burcak G. Hyperuricemia in hypothyroidism: is it associated with post-insulin infusion glycemic response? Tohoku J Exp Med 2003; 199: 59-68. [10] Isomaki H. Hyperuricemia in northern Finland. An epidemiological study of serum uric acid in rural, urban and hospital populations. Ann Clin Res.1969; 1(Suppl 1): 1-62. [11] A Haque Khan1, I Majumder Serum Creatinine and Uric Acid Levels of Hypothyroid Patients. Bangladesh J Med Biochem 2010; 3(2): 61-63 [12] Jia D, Liang LB, Tang GH, He H, Zhang M, Li ZP, Li SQ.The Association Between Serum Uric Acid and Creatinine in Patients with Hypothyroidism. Sichuan Da Xue Xue Bao Yi Xue Ban. 2015 Sep;46(5):747-

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